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In support of the global mission that DoD is undertaking to secure American interests
in a multi-threat world, U.S. combat medics and medical personnel are prepared to risk life
and limb in support of their fellow personnel, doing so with a confident grace. It is in this
vein that Tactical Defense Media dedicates the Winter 2016/2017 issue of its Combat &
Casualty Care publication to the well-being of those who serve.
Leading off is a look at the single largest military healthcare system records-keeping
overhaul in history. In an exclusive interview with Ms. Stacy Cummings, Program Executive
Office Defense Healthcare Management Systems (PEO DHMS), we get a clearer picture
regarding PEO DHMS’ role in oversight of a $4.3 billion effort to deliver a modernized,
interoperable electronic health record for active servicemembers and their families, as
well as veterans. As an integrated system, the program, referred to as MHS GENESIS, is
intended to facilitate safe transition of care across the spectrum of military operations to
include garrison, operational, and en-route care. From point of injury to military treatment
facilities, patients’ health record will be available to providers.
This issue’s Commander’s Corner interview spotlights the U.S. Army Institute of
Surgical Research (USAISR) optimizes techniques in casualty care to maximize positive
outcomes. An interview with Col (Dr.) Shawn Nessen, Commander, USAISR, speaks to
current critical focal efforts including tourniquets and blood utilization on the battlefield,
research on blood transfusion for point of trauma application, and advances in burn
trauma treatment, to name a few. To continue in a research vein, the latest in U.S. Defense
Advanced Projects Agency medical capabilities study offers a look into DARPA’s ongoing
work with interactive brain to robotic arm sensory connectivity for achieving movement in
cases of limb paralysis or amputation.
From a mobile care perspective, readers gain insight into the targeted training
conducted by the U.S. Army Medical Department in providing realistic training for flight
paramedic personnel. Employing state-of-the-art simulation tools in real-world application
scenarios, the course prepares active, reserve and Guard medical professionals to address
the challenges of administering care amidst the challenges of medical evacuation. This
issue also shines a light on Walter Reed Army Institute of Research (WRAIR), Silver Spring,
MD, specializing in among many areas, the study of infectious diseases on deployed troops
in theater. As such, the Institute offers an Operational Clinical Infectious Disease (OCID)
Course for deploying personnel to prepare them for avoiding and treating symptoms
related to infectious diseases endemic to certain global regions.
As always, we welcome any comments or suggestions. Happy reading!

MODERNIZING FOR
ADAPTABLE HEALTHCARE
The U.S. Department of Defense is deploying
a single integrated inpatient and outpatient
electronic health record (EHR) to supply Military
Health System (MHS) providers throughout the
continuum of care, as well as private sector
healthcare partners, with the necessary data
to collaborate and make the best possible
healthcare decisions.
By Ms. Stacy A. Cummings
Program Executive Officer
Defense Healthcare Management Systems

Ms. Stacy Cummings serves
as the Program Executive Officer
for the Program Executive Office,
Defense Healthcare Management
Systems. As Program Executive
Officer, Ms. Cummings oversees
the Department of Defense electronic health record modernization
including the operational, data
exchange, and interoperability initiatives. Specifically, she
provides direction to the following program management
offices: the DoD Healthcare Management System Modernization, the Joint Operational Medicine Information Systems, and
the Department of Defense/Department of Veterans Affairs
Interagency Program Office.
Ms. Cummings previously held senior executive positions
at two operating administrations within the Department of
Transportation where she established strategic direction,
provided executive leadership and managed daily operations.
Additionally, Ms. Cummings served as the Department’s
executive sponsor for the Joining Forces initiative to connect
service members, veterans, and their families with career
opportunities in transportation.
Beginning her career as an Acquisition Logistics Intern
at the Naval Air Systems Command, Ms. Cummings spent
17 years with the Department of the Navy where she gained
expertise in logistics, maintenance support and information
technology acquisition and deployment. She held senior
positions with the Naval Air Technical Data and Engineering
Services Command; Commander, Fleet Readiness Centers;
Program Executive Office for Command, Control, Communications, Computers and Intelligence; and the Space and Naval
Warfare Systems Command.

4 | Combat & Casualty Care | Winter 2016/2017

The mission of the Program Executive Office Defense Healthcare
Management Systems (PEO DHMS) is to transform the delivery
of healthcare and advance data sharing through a modernized
electronic health record for service members, veterans, and their
families. To meet this mission, we are deploying a single integrated
inpatient and outpatient electronic health record (EHR), branded
MHS GENESIS. The deployment of technology will supply Military
Health System (MHS) providers throughout the continuum of care, as
well as our private sector healthcare partners, with the necessary to
data to collaborate and make the best possible healthcare decisions.
As part of the DoD-wide EHR modernization effort, PEO DHMS
certified interoperability with the Department of Veterans Affairs
(VA) in April 2016. Today, the Department of Defense (DoD) and VA
share more health data than any other two major healthcare systems.
From a technology perspective, the modernization effort ensures
that data captured from service members’ health records is shared
with the VA and commercial/civil healthcare providers as the service
member transitions to veteran status. Approximately 60 percent
of beneficiaries receive their healthcare from outside the DoD. The
relationship between military and civilian healthcare providers, where
medical professionals on both sides can access critical patient
information, is vital to maximizing positive patient outcomes. Health
data sharing is a critical part of the mission we deliver today.

Acquisition of MHS GENESIS
In 2013, the DoD made the decision to move away from homegrown government-developed EHRs to a commercial-off-the-shelf
(COTS) capability. Two main factors contributed to this decision.
With advances in technology, the needs within the MHS could be

better met by commercial applications. Second, from a life cycle
cost and affordability vantage point, the DoD could take advantage
of investments in technology and clinical practices made in recent
years as well as increased data sharing with civilian partners.
Staying current with technology advancements without being the
only investment stream will enable the DoD to benefit from some of
the best products in health IT without carrying the financial burden
alone.
To engage with industry, DoD held a number of industry day
gatherings to meet with healthcare providers and organizations
in the private sector, and engage with stakeholders within the
MHS community to identify requirements and standard workflows.
Information gleaned from these meetings and stakeholder
engagements led us to develop a robust list of requirements. In the
end, the DoD recognized that business processes and workflows
within the MHS were similar to the processes used by the commercial
sector.
In July 2015, the DoD awarded a $4.3 billion contract to the
Leidos Partnership for Defense Health (LPDH) to deliver a modern,
interoperable EHR. The LPDH team consists of four core partners,
Leidos Inc., as the prime developer, and three primary partners in
Cerner Corporation, Accenture, and Henry Schein Inc. MHS GENESIS
provides a state of the market COTS solution consisting of Cerner
Millennium, an industry-leading EHR, and Henry Schein’s Dentrix, a
best of breed dental module.
As an integrated system, MHS GENESIS will facilitate the safe
transition of care across the spectrum of military operations to
include garrison, operational, & en route care. From point of injury to
the military treatment facilities, the patients’ single health record will
be available to providers.

Deployment Strategy
We are employing industry best practices as we deploy and
optimize the delivery of MHS GENESIS. MHS GENESIS will deploy
via a “wave” model. Initial fielding sites in the Pacific Northwest are
the first wave of MTFs to receive MHS GENESIS beginning February
2017. This will provide an opportunity to perform operational testing
activities to ensure MHS GENESIS meets all requirements and to
capture lessons learned to subsequent wave deployments.
Currently, there are a variety of ongoing deployment activities.
PEO DHMS effectively manages engineering, testing, logistics,
business operations, change management, and communications to

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ensure a successful deployment of MHS GENESIS to a complex and
globally dispersed user base.
To meet military unique needs, MHS GENESIS will interface with
select legacy systems. To date, 23 interfaces have been identified
as required at initial fielding sites. Additional interfaces will be
prioritized and scheduled for completion during initial deployment and
subsequent wave deployments.
MHS GENESIS will replace select DoD legacy healthcare systems,
including but not limited to: AHLTA, Composite Health Care System

(CHCS), inpatient, and components of the Theater Medical Information
Program-Joint (TMIP-J).
When fully deployed, MHS GENESIS will provide a single health
record for service members, veterans and their families across the
continuum of care. It will also enable clinical analytics that will
improve healthcare delivery and drive efficiencies and cost savings for
years to come.
More info: health.mil/dhms

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6 | Combat & Casualty Care | Winter 2016/2017

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FACILITATING A SEAMLESS TRANSITION
New Military Electronic Health Records (EHR) System is intended to fill the gap between military
and civil medical care providers for active and veteran servicemembers
Navy Vice Adm. Raquel Bono, director of the Defense Health
Agency (DHA), remarked recently that the implementation of a new
electronic health records system could help facilitate interoperability between mobile service personnel and healthcare providers.
Bono said during her keynote speech at an Armed Forces Communications and Electronics Association event in October that the
Military Health System will begin to launch the MHS Genesis EHR
system in February in the Pacific Northwest with a plan to fully roll
out the system within six years.
“We had a wonderful exchange in building the requirements

for this with industry,” Bono said of the EHR platform at AFCEA
Bethesda, Maryland chapter’s Health IT Day 2016.
“It really alerted us to some of the solutions that were out there
we were looking for, recognizing that we have some unique challenges with our globally distributed patient population and also our
providers and military treatment facilities,” she added.
MHS has delayed the launch of the MHS Genesis system from
December to February due to technical and compatibility issues
identified during early tests.
More info: Health.mil

TARGETING FULL-SPECTRUM
DENTAL CARE
As a core member of the Leidos Partnership for Defense Health (LPDH), Henry Schein’s, Dentrix
Enterprise, to DoD’s Electronic Health Record (EHR) Military Health System (MHS) GENESIS.
By Kevin Bunker, President, Henry Schein North America Dental Practice Solutions
MHS GENESIS provides access to medical and dental information in one record, which helps centralize patient data, simplify
multi-location management, and ultimately improves patient care
for active duty servicemen and the 9.6 million beneficiaries in the
Military Health System receiving services at over 1,200 locations in
16 different countries.
Specifically, Dentrix Enterprise features an appointment book,
which maximizes production through visual, goal-oriented scheduling; a patient chart, which tracks patient clinical information,
including existing, recommended and completed treatments, or
conditions; a treatment planner, which provides patients with easyto-understand treatment; a periodontal chart, which records mobility, furcation grades, plaque, calculus levels and bone loss, among
other health issues; as well as features a continuing care module,
which monitors patients’ pending dental care.

Holistic Individualized Approach
At a time when we’re learning more and more about the
impact of oral health on overall health, and when the seamless
sharing of medical and dental records is paramount, having a
complete picture of health is critical for our military service men

and women and their beneficiaries. For years, Dentrix Enterprise
has been used by numerous community health centers, federally
qualified health centers, Indian Health Service (IHS), and other
government agencies because it interoperates with numerous
medical systems, providing patients with this complete picture
of their health.
While most other dental practice management systems used
in large group practices and health centers evolved from medical systems, Dentrix Enterprise engineers worked directly with
dentists to design a system that delivers the dental-specific
workflows they need to run an efficient clinic or practice.

Pushing the Care Envelope
By continuing to meet the market needs of our customers,
which includes the DoD, Henry Schein will continue to play a role in
helping improve the exchange of vital health information between
the public, private, and government medical and dental providers
so patient health data becomes more complete and health providers everywhere have all the health information and access they
need to provide the best care possible.
More info: henryschein.com

The U.S. Army Medical Department Center & School (AMEDDC&S), Ft. Sam Houston, TX provides
realistic training for flight paramedics employing state-of-the-art simulation in preparing
personnel to apply care necessary to affect positive real-world outcomes.
By Kevin Hunter, C&CC Editor
The Flight Paramedic Recertification Course is intense, stressful,
fast paced, and most importantly realistic. So realistic in fact that
Sergeant Marty Anderson, a certified emergency medical technician
(EMT) and member of the Michigan National Guard attending the
course said, “Being inside a helicopter trainer is very different than
being in the back of an ambulance. We’re wearing full battle rattle, it’s
dark, loud, and windy. The intense exercise feels likes a real helicopter
with a live patient,” said Anderson describing the experience of
treating an injured patient inside a UH-60 Blackhawk trainer. Sergeant
Anderson is no stranger to emergency medical care. He works as an
EMT in Lansing, Michigan. Emergency care is what he does for a living
when not serving with his unit Detachment 1, C Company, 3-238th
Aviation Battalion. Anderson recommends that every flight paramedic
8 | Combat & Casualty Care | Winter 2016/2017

in the U.S. Army attend the course. “I am so glad I came to this class.
I’m taking what I learned to my civilian job and Guard unit.”

Building on Paramedic-ready
Taught at the U.S. Army Medical Department Center and School
(AMEDDC&S) the course provides Army enlisted Health Care Specialists
(68W), who are paramedic qualified, two-weeks of training required
for paramedic recertification to include 72 hours of continuing
education units accredited by Army Emergency Medical Service (EMS).
Additionally, students who are flight paramedic certified through the
Board of Critical Care Transport Paramedic Certification (BCCTPC)
qualify for continuing education units.

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Practical exercises include airway management, treatment of
extremity trauma, treatment of combat chest wounds, and lifesaving
emergency surgical skills on high fidelity simulation manikins.
Students conduct scenarios in both clinical environment and high
fidelity aircraft environment. All training scenarios and exercises
refresh critical care knowledge and provide recertification.
AMEDDC&S is using the most advanced hands-on medical
simulators ever made. Synthetic human simulators constructed from
polymer composites are replacing tissue in medical education with a
realness not possible with older rubber manikins. These innovative
devices mimic the mechanical, dielectric and physicochemical
properties of relevant living tissue. The skin, organs, ligaments,
cardiovascular system, nerves, bones, and flesh textures look and feel
authentic, based on actual live tissue tests to mimic the properties of
living tissue with an unmatched level of fidelity. These simulators even
have beating hearts, breathing lungs, moving limbs, and even pump
simulated blood through arteries and veins.
Students can insert their hands and medical instruments then pull
back internal body parts for detailed examinations. Tissues respond
to all known imaging techniques and medical devices just like live
tissue. The materials are about eighty-five percent water, and to
prevent dehydration the training simulators are stored in tanks with
recirculating fluid. Wireless integrated computer interfaces include
controls proving students with vital physiological information on
untethered tablets.
These advanced systems are better suited for a new generation of

Students practice inserting a tracheal tube on a medical human simulator. (Army)

Soldiers who have grown up with Smartphones. The medical patient
simulators used at AMEDDC&S have come a long way from the old
CPR Annie manikins from the past. While those training manikins

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Flight paramedic course instructor Sergeant First Class Reid Carpenter prepares a SynDaver medical simulator. AMEDDC&S has invested over $100,000 in each human simulator. These
simulators are industry best with realistic polymer skin, internal organs, bone, nerves, and even pump simulating blood fluids. Instructors can wirelessly operate and monitor the
simulators for different physiological training exercises. (Army)

were hard plastic, featureless device, more like a department store
manikin, today’s systems are so life-like, even seasoned instructors
have difficulty distinguishing them from real tissue.

Mobile Module on Mission
The Training Mobile Transport Lab, a life-sized UH-60 platform,
offers students stressful experience of being inside a real helicopter
with sound, wind, and smoke. Instructors conduct nighttime training
scenarios, where flight paramedic students treat patients inside the
cargo compartment. The training prepares flight paramedics to load
and unload patients on litters and treat them in flight. The training
exercise is fast paced and realistic, testing students ability to treat
injuries while transporting patients.
Along with the practical classroom exercises, students take
part in interactive lectures from insightful subject matter experts,
or SMEs, on a host of medical topics. “The small block lectures are
phenomenal. We’re learning from SMEs with real life experience. This
training supersedes anything they received in initial 68W training,” said
Sergeant Anderson.
As traditional classroom, online, and practical training methods
advance, AMEDDC&S continues to invest in new methods and
technologies, while preserving the tried and tested techniques that
have led to the U.S. military having the highest combat survivability
rate in history.
10 | Combat & Casualty Care | Winter 2016/2017

Until recently, 68Ws could only provide immediate first aid while
preparing the wounded for transport to a military field hospital facility.
A gap existed between treatment at the point of injury and transport
to a treatment facility. In the civilian world, air ambulances provide
on-scene and in-transit treatment with dedicated, specially trained,
and certified flight paramedics. Yet the U.S. Army lacked this life
saving ability. To close that gap, AMEDDC&S established the Critical
Care Flight Paramedic Program. Now Army helicopters are more than
flying ambulances shuttling the injured to a military treatment facility.
Advanced trauma management is accessible at or near the point of
injury and while flying to a treatment facility.
“I think about how it must have felt to be a flight medic without
skills to help an injured Soldier beyond basic first aid,” reflected Major
Ersan Capan, the officer-in-charge of the Critical Care Flight Paramedic
Program, Transport Medical Training Laboratory. “How horrible it was
for an Army medic to see critically injured patients and not have the
skills to treat them. To take that with them for the rest of their lives.
In the past these 68Ws were little more than part of a flight crew with
basic medical training. Now we are giving our 68Ws the skills to provide
in flight critical care, similar to civilian helicopter flight paramedics,”
said Capan. He and his team were instrumental in standing up the
curriculum for the flight paramedic recertification course.
“We want our students knowing they did everything possible to
save lives, and not to think about what they couldn’t do,” said flight
paramedic instructor Sergeant First Class Reid Carpenter. “We give

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A U.S. Force paramedic practices inserting tracheal tube on a medical simulator manikin
while assisted by two U.S. Army Health Care Specialists (68W). The U.S. Army Medical
Department Center and School also trains Airmen in the Flight Paramedic Recertification
Course on a space available basis. (AMEDDC&S)

“Our goal is to show Soldiers what it’s like in the field. We want
them to know what to expect, so they’re prepared to save lives,” said
Major Capan. “The Army has an incredible battlefield injury survival
rate. Yet there were a number of Soldiers we weren’t able to save
because they didn’t receive critical care treatment in time. Now the
Soldiers we’re training in this course are equipped to save those lives.
We’re closing the gap with each flight paramedic we train.”

Sergeant Marty Anderson, Detachment 1 C Company, 3-238th Aviation Battalion, Michigan
National Guard, monitors the status of a medical patient simulator while onboard a UH60 Blackhawk trainer. Taught at the U.S. Army Medical Department Center and School,
the flight paramedic course trains 68Ws medical enlisted personnel with the knowledge
and skills required to conduct advanced critical care pre-Medical Evacuation (MEDEVAC)
treatment, loading and unloading patients in MEDEVAC aircraft, and stabilize and treat
patients in flight. The life sized UH-60 trainer offers students the opportunity of realistic
classroom exercises emulating the sound, wind, and stressful environment of an actual
helicopter. The advanced patient simulators used at AMEDDC&S provide students with
vital signs, clinical signs, and symptoms mimicking live patients. (Army)

68Ws capabilities to meet Army needs. To maintain their skills flight
paramedics need to continuously train when back at their units. These
Soldiers are more than just part of a flight crew; they are now front
line critical care medics. There is an overlapping of skills, almost like
a hybrid of combat medics, physician assistants, and nurses. These
68Ws also understand medications. Once they complete the course
Soldiers then serve as the critical care paramedic for their platoon,”
said Carpenter.

Setting Stage for Career Growth
For commanders, having a Soldier away from their unit training
for two weeks is a significant amount of time. Yet ask any of the
students that have gone through the course and each will agree it is
a worthwhile investment. Aviation units benefit from having trained
flight paramedics able to provide critical care beyond the basic 68W
requirement. “We teach them a lot, but these skills are perishable. We
emphasize that when students return back to their aviation units they
need continuous training, the same as civilian flight paramedics,” said
Sergeant Carpenter.

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Winter 2016/2017 | Combat & Casualty Care | 11

COMMANDER’S CORNER

INNOVATING TO MAXIMIZE
POSITIVE OUTCOMES
COL (Dr.) Shawn C. Nessen grew up in the small town of Tremonton, Utah and attended Idaho State University on a football
scholarship where he received a Bachelor of Science in Zoology
and Biology in 1990 cum laude and also graduated as a Distinguished Military Cadet. He then attended Des Moines University
School of Osteopathic Medicine receiving a Doctor of Osteopathic
Medicine degree in 1995. He completed his residency in General
Surgery at William Beaumont Medical Center in El Paso, Texas in
2000 and in 2011 completed a Fellowship in Acute Care Surgery
and Critical Care Surgery at the University of Nevada School of
Medicine University Medical Center in Las Vegas, Nevada. He is
board certified in general surgery and critical care surgery.
COL Nessen completed his ROTC training in 1988 and was
commissioned in the early commissioning program as a 2nd Lt.
He then served as an Armor Platoon Leader in the Idaho National
Guard until he entered medical school in 1991 on a scholarship
from the Armed Forces Health Professions Scholarship Program.
Following completion of residency in 2000, he served as a staff
surgeon and later Chief of the General Surgery Service at Fort
Riley, Kansas where he concurrently served as the flight surgeon
for the 82nd Air Ambulance Company. COL Nessen deployed to
Iraq during Operation Iraqi Freedom for nine months in 2003.
There he served as a surgeon for the 28th Combat Support Hospital and also flew multiple medical officer missions with the 82nd
Air Ambulance Company. In 2005, following completion of the
U.S. Army Command and General Staff Command, COL Nessen
assumed command of the 782nd Forward Surgical Team (Airborne) which later was reflagged as the 541st FST (Airborne). His
command of these two units included a humanitarian deployment
to New Orleans after Hurricane Katrina and a 15 month deployment in support of Operation Enduring Freedom from October
2006 to February 2008 in Afghanistan. There, his team successfully conducted split based operation in the Paktika and Helminth
Provinces and treated over 800 combat wounded, performed over
500 surgeries and procedures, transfused 1,300 units of blood
and achieved a 97.64 percent survival rate for all casualties. Upon
completion of Fellowship training in 2011, COL Nessen became
the Deputy Commander for Clinical Services of the 212th Combat
Support Hospital in Miseau, Germany. While in this position, he
also served as a staff Critical Care Surgeon at Landstuhl Regional
Medical Center located in Landstuhl, Germany, and in 2013, COL
Nessen became the Chief of the Department of Surgery at LRMC.
From Germany, COL Nessen transferred to Martin Army Community Hospital at Fort Benning, GA where he served as the Deputy
Commander for Clinical Service.
COL Nessen’ s military education includes graduation from
the U.S. Army Medicine Department Officer Basic and Advanced
Courses, the Army Flight Surgeons and Airborne Courses, and
Command and General Staff College where he received a Masters
of Military Arts and Sciences in the field of Strategy.
Interview conducted by C&CC Editor Kevin Hunter

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COL Shawn Nessen
Commander
U.S. Army Institute of Surgical Research (USAISR)
Fort Sam Houston, TX
C&CC: Speak to your role as commander and primary organizational
mission.
COL Nessen: The mission of the United States Army Institute of
Surgical Research is to “Optimize Combat Casualty Care” and no group
of people have done more to improve survivability on the battlefield
than the dedicated civilians and military personnel that work at
the ISR. Great examples of innovations driven by the ISR include
tourniquets and blood utilization on the battlefield. Tourniquet use
decreased preventable deaths from extremity injury from 28 percent
of preventable deaths to just 3 percent and the research conducted on
blood transfusion have changed how we resuscitate trauma victims,
not just on the battlefield, but in civilian institutions worldwide. What
we decide to study at the ISR can be requirement driven, or it can
result from the ongoing performance improvement efforts of the Joint
Trauma Service or the ISR Burn Center.
My role as commander in many ways is to stay out of the way of
the brilliant people who have done so much for our Soldiers over the
past few years. I encourage everyone at the ISR to be creative and
innovative and to pursue research they believe will be effective. To that
end, my job is to remove obstacles and ensure that all teams in every
task area have what they need to succeed.
Winter 2016/2017 | Combat & Casualty Care | 13

COMMANDER’S CORNER

COL Nessen, right, as a Lt. Col. and commander of the 541st (Airborne) Forward Surgical Team and surgical team members in Afghanistan while deployed in support of Operation
Enduring Freedom. (USAISR)

I do believe however, that we need to look at the personal dimension; the human dimension. I spent nine months in Combat Support
Hospitals in Iraq in 2003 and then 15 months in Afghanistan from
October 2007 to early 2008 as a Forward Surgical Team commander.
And also, three years in different capacities at Landstuhl Regional
Medical Center, so I do have a lot of experience as a trauma surgeon at
Role 2, 3 and 4. My experience tells me we can do better. I believe we
need to take a hard look at preventable deaths and our outcomes when
it comes to the most severely wounded on the battlefield. Are we providing the medical and surgical care required at the or near the point
of injury? This is not just a time to surgery issue. It is also a capability
issue. Do our forward surgical assets have the capabilities required
to achieve the expected outcomes? Do our hospitals? I believe if we
analyze the data we have collected over the past three years, we will be
able to quantify the risk of mortality based on the available capability.
So, we will be taking a look at battlefield surgery from the perspective
of preventable deaths for the next two years at least.
C&CC: What are some key areas of focus and how is the USAISR
addressing these?
COL Nessen: The ISR has five directorates and 12 Task Areas that
cover diverse areas of research ranging from wound specific treatment
for burns and blast injury to blood transfusion and dental trauma.
14 | Combat & Casualty Care | Winter 2016/2017

To give you some idea of the scope of the research we are doing,
consider the ISR had 104 poster and podium presentations presented
at the Military Health System Research Symposium last summer. The
quality of the research is impressive and continues to advance our
understanding of battlefield injuries. We will continue to study blood
transfusion, antibiotic efficacy, tissue rejection after transplant, burn
injury and many other topics. The ISR has over 700 personnel and the
number of research protocols and ongoing projects are numerous, so it
is impossible to talk about them all here, but I will say you never know
where the next breakthrough will come from and I want to be careful
to identify “key areas of focus” because I believe everyone working at
ISR is doing important work and I want them to know that. I have never
worked in an organization that was more enthusiastic and motivated
than the ISR. Everyone understands the importance of their work and it
reflects in the esprit de corps that permeates the organization.
C&CC: In terms of field surgical technique, how is the USAISR assisting
in taking progress learned in house and applying it to field combat
scenarios?
COL Nessen: It is an interesting question and it depends I think on
what you consider our house. The Burn Center is part of the ISR and
the research questions driven by our care burn victims obviously have
a direct correlation to battlefield injury. Our outcomes from our service

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COMMANDER’S CORNER

COL Nessen, second from right in the middle row, then a Lt. Col. and commander of the 541st (Airborne) Forward Surgical Team in Afghanistan while deployed in support of Operation
Enduring Freedom. (USAISR)

members suffering from burns have been remarkable and I have no
doubt burn research at ISR is the best in the world. The Joint Trauma
System has a little larger house, but it works just like the Burn Center.
JTS collect battlefield performance data and then conduct research to
improve outcomes. They conduct a weekly worldwide teleconference
and discuss specific patients to this day and the theater practice
guidelines are a direct result of the data they have collected. JTS
also created the Committee on Tactical Combat Casualty Care which
has been enormously successful. They have produced and continue
to refine the Tactical Combat Casualty Care guidelines which are
the standard for combat medics. This is where the end user sees
the results of our research as he or she learns to apply a tourniquet,
administer antibiotics or treat pain as examples.
The success of the TCCC has been such that JTS is now working
to put together a similar committee for tactical combat surgical care.
This committee will try to answer some of the questions I spoke of
earlier as it pertains to Role 2 and 3. What is the Role 3 basic capability for joint forcible entry operations is one question I would like to
address for example. But, there are many others and the collective
intellectual capacity of the committee will be a powerful generator of
future research at the ISR. The committee approach also allows us to
reach outside of the institute for ideas. We have many service members with substantial and diverse experiences on the battlefield and we
very much want to tap into that experience. When I deployed in 2007
with my FST, Col. John Holcomb, who was the commander of the ISR at

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that time, would reach out to me frequently to update me on the latest
discoveries and also to ask me what I thought needed to be evaluated.
The accurate records we kept via the Joint Theater Trauma Registry
later produced three quality papers on FST operations in Afghanistan.
So, if we don’t reach out to you, please contact us with your ideas and
we will try to help with the IRB and statistical analysis.
To close, I would like to say how proud and honored I am to be the
commander of the USAISR! I feel lucky to come to work every day and
work with Soldiers, Sailors, Marines, Airmen, and civilians who work
here. They represent some of the finest scientific minds our nation
has to offer. At the MHSRS meeting I was amazed at how many
enlisted Soldiers and Non-commissioned officers presented posters.
I was 42 years old and a Lieutenant Colonel when I presented my first
poster at MHSRS! The young talent assembled here will make breakthroughs in patient care that I can’t even begin to contemplate. I am
confident we will continue to meet our mission to optimize combat
casualty care.

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Winter 2016/2017 | Combat & Casualty Care | 15

MedTech

Navy Medicine Milestone

New Spec Ops Medical Course

Naval Medical Center San Diego recently debuted its
latest advancement in patient care when Ophthalmologists
here performed their first Femtosecond Laser-assisted
Cataract Surgery (FLACS) - the first ever performed at a
military medical facility.
“FLACS offers many benefits over the conventional
Phacoemulsification Cataract Surgery (PCS), such as
increased precision, improved effective lens positioning,
and less damage to surrounding tissue. Cataract surgery
has evolved greatly over the past two decades and these
advances have resulted in increased safety, faster recovery,
and outstanding visual outcomes providing a better
experience for our patients,” said U.S. Navy Capt. Frank
Bishop, lead Ophthalmologist at NMCSD, adding that FLACS
uses laser energy to perform many of the steps of cataract
surgery, providing surgeons with unprecedented control and
accuracy.
Most modern cataract surgery is microsurgery performed
by using phacoemulsification, which requires small incisions
(wounds) to the eye using a small scalpel-like instrument and
the use of a small ultrasonic device to break up and remove
a cloudy lens, or cataract, from the eye. In FLACS, the laser
makes the wounds, and begins the process of breaking up
the cataract lens. Use of the laser increases the precision
of these steps. Additionally, the FLACS procedure offers the
surgeon the ability to treat astigmatism by making precision
corneal incisions that optimize the eye shape and enhance
vision.
More info: med.navy.mil

A NATO Special Operations Combat Medic (NSOCM) pilot
course debuted at the International Special Training Centre
(ISTC) on Oct. 3, 2016.
The newly developed 22-week course will take international
special operations forces (SOF) and operators with basic
combat lifesaver skills and train them to be combat medics
who are able to sustain casualties up to 36 hours.
The NSOCM pilot course will cover 174 NATO-recognized
critical tasks in trauma and non-trauma clinical medicine,
injuries, illnesses and conditions; and it comes after ISTC’s
Advanced Medical First Responder Course that teaches initial
treatment and care for a patient on a battlefield.
This multinational NSOCM course will teach theoretical
and tactical medicine to 24 students annually, during nine
modules taught by international guests, special topic experts
and ISTC instructors. The pilot course began with students
from Austria, Belgium, Germany, Greece, Italy, the Netherlands,
Norway, Poland, Switzerland, and the United States.
More info: med.navy.mil

Fish Skin Solution for Burn Trauma
Kerecis™, a company which uses fish skin to heal human
wounds and tissue damage, this past summer presented
clinical results demonstrating the efficacy of its fish-skin
technology for treating battlefield wounds. The presentations
took place at the Military Health System Research Symposium
(MHSRS) in August.
Casualties caused by improvised explosive devices have
increased in frequency, size and severity in the past decade.
Such casualties, which primarily affect the unprotected areas
of the body, are difficult to treat under battlefield conditions.
The number of burns from activities in current theatres of
operations has almost quadrupled, making their effective
medical treatment even more important to the military.
Kerecis is working on several projects with Department
of Defense (DOD) entities where the advantages of using
fish skin for skin-graft substitution and sparing are being
investigated for front-line deployment. Kerecis woundcare product is now available for U.S. Veterans through the
Government Services Administration (GSA).
More info: kerecis.com

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New Experts Join
Drug Delivery Innovator
Portal Instruments, Inc., an emerging leader in the
development of innovative drug delivery systems, has
announced that Robert Langer, Sc.D., MIT Institute Professor,
and Peter Hunter, Ph.D., University of Auckland Distinguished
Professor have joined the company’s Scientific Advisory
Board.
“We are thrilled to welcome two esteemed biotechnology
leaders, Professor Robert Langer and Professor Peter Hunter,
to our team,” said Dr. Patrick Anquetil, Chief Executive
Officer of Portal Instruments. “We will benefit greatly from
their combined and extensive expertise in drug delivery,
physiological modeling, and medical device development, as
we transition our efforts from research and development to
clinical studies and future commercialization.”
Professors Langer and Hunter will join current Scientific
Advisory Board Chair, Ian Hunter, Ph.D., co-founder of
Portal Instruments and MIT Hatsopoulos Professor of
Mechanical Engineering, as Portal continues to develop a
digitally-controlled, needle-free drug injection system to
simultaneously transform the delivery of modern medicines
and improve the patient experience.
Anquetil continued, “We look forward to the insights
and contributions Professors Langer and Hunter will make,
to push our device to the next level. We believe their
unique perspectives with regard to the intricacies of delivery
physiology, design for inherent patient variability, and the
implementation of clinical investigations will provide a strong
benefit to the company.”
More info: portalinstruments.com
Winter 2016/2017 | Combat & Casualty Care | 17

DARPA DOTS

DARPA

RESTORING
A
SENSE
OF TOUCH
Combat & Casualty Care provides readers with a look at a ground-breaking research program at
the U.S. Defense Advanced Research Projects Agency for enabling interactive brain to prosthetic
arm sensory connectivity for achieving movement in cases of limb paralysis or amputation.
By DARPA Outreach Public Affairs
A U.S. Defense Advanced Research Projects Agency (DARPA)funded research team has demonstrated for the first time in a human,
a technology that allows an individual to experience the sensation of
touch directly in the brain through a neural interface system connected
to a robotic arm. By enabling two-way communication between brain
and machine—outgoing signals for movement and inbound signals
for sensation—the technology could ultimately support new ways for
people to engage with each other and with the world.
18 | Combat & Casualty Care | Winter 2016/2017

The work was supported by DARPA’s Revolutionizing Prosthetics
program, and performed by the University of Pittsburgh and the
University of Pittsburgh Medical Center. The results were detailed
in a study published online in the journal, Science Translational
Medicine and the technology was among a number of advanced
demonstrations presented to President Barack Obama at a White
House innovation event in Pittsburgh.
“DARPA has previously demonstrated direct neural control of a
robotic arm, and now we’ve completed the circuit, sending information
from a robotic arm back to the brain,” said Justin Sanchez, Director

of DARPA’s Biological Technologies Office and the program manager
for Revolutionizing Prosthetics. “This new capability fundamentally
changes the relationship between humans and machines.”

Synching Neural and Sensory
The volunteer for the study, Nathan Copeland, has lived with
quadriplegia from the upper chest down since a 2004 car accident
that broke his neck and injured his spinal cord. Nearly ten years
following his accident, after agreeing to participate in clinical trials,
Nathan underwent surgery to have four microelectrode arrays—each
about half the size of a shirt button—placed in his brain, two in the
motor cortex and two in the sensory cortex regions that correspond
to feeling in his fingers and palm. The researchers ran wires from
those arrays to a robotic arm developed by the Applied Physics
Laboratory (APL) at Johns Hopkins University. The APL arm contains
sophisticated torque sensors that can detect when pressure is
being applied to any of its fingers, and can convert those physical
“sensations” into electrical signals that the wires carry back to the
arrays in Nathan’s brain to provide precise patterns of stimulation to
his sensory neurons.
In the very first set of tests, in which researchers gently touched
each of the robotic fingers while Nathan was blindfolded, he was able
to report with nearly 100 percent accuracy which finger was being
touched. The feeling, he reported, was as if his own hand were being
touched.
“At one point, instead of pressing one finger, the team decided to
press two without telling him,” said Sanchez. “He responded in jest
asking whether somebody was trying to play a trick on him. That
is when we knew that the feelings he was perceiving through the
robotic hand were near-natural.”
These latest results build on a series of DARPA achievements in
directly interfacing the brain with a robotic arm. Earlier studies with
volunteers Tim Hemmes and Jan Scheuermann demonstrated motor
control of the APL arm using a brain-machine interface. “Based on
DARPA’s success with those early tests, we asked, ‘Can we do the
experiment in reverse and do for sensation what we did for the motor
system?’” Sanchez said.

together thought leaders and expert scientists and engineers to
generate new ideas and accelerate the development of novel
capabilities.
The interface system is one of two dozen technological
breakthroughs on display at The White House Frontiers Conference,
where Nathan and the lead researchers from Pitt talked about the
technology, what it could mean for people living with spinal cord
injury, and what new possibilities it could open for society.
Part of the President’s Brain Initiative, DARPA’s Revolutionizing
Prosthetics program is funding research to refine stimulation
patterns and incorporate new types of sensations beyond pressure
to achieve the goals of delivering near-natural motor control and
sensation to users of prosthetics. Improvements in these and
related neuro-technologies could someday lead to near-seamless
combinations of the cognitive functions of the human brain and the
computing processes of machines.
Revolutionizing Prosthetics is not DARPA’s only program to
pursue the restoration of a sense of touch to amputees. The Agency’s
Hand Proprioception and Touch Interfaces (HAPTIX) program is
pursuing an alternative approach, using the peripheral nervous
system to communicate motor commands and sensory feedback
between the brain and a prosthetic limb. The program plans to
initiate take-home trials of a complete, FDA-approved HAPTIX
prosthesis system by 2019.
More info: DARPA.mil

Nationally-backed Science
DARPA previewed its success with touch restoration in 2015 at
“Wait, What? A Future Technology Forum,” an event that brought

MEDICAL LOGISTICS CITATION
Army Surgeon General Lt. Gen. Nadja Y. West and Army Medical
Department Civilian Corps Chief Gregg Stevens presented the 2016
4th quarter Army Medicine Wolf Pack award to the U.S. Army Medical
Research and Materiel Command’s Total Lifecycle Management Team
during a ceremony at Fort Detrick, Maryland, Oct. 11.
The Wolf Pack award recognizes an integrated team of military and
civilian members whose accomplishments demonstrate excellence
and effective teamwork resulting in significant products or services
with the potential for broad impact in support of Army Medicine. The
Total Lifecycle Management team was comprised of 20 military and
civilian employees from the U.S. Army Medical Materiel Agency and
the U.S. Army Medical Materiel Development Activity, both subordinate
organizations of USAMRMC.
This quarter’s Wolf Pack award recognized the team’s combined
efforts to efficiently and effectively equip and sustain the Army,
ensuring a medically ready and a ready medical force. In 2015,
USAMMA appointed an accountable officer and supply specialists
at each of its stateside medical maintenance depots to ensure an
accurate record of property, documents and funds for each of the
depots, which total $125 million in medical equipment. USAMMA
then completed a 100 percent inventory at all of its medical depots,
coordinating with the USAMMA’s Business Support Office to leverage
a barcode system that allows for a valid enterprise-wide system of
record using the Theater Enterprise Wide Logistics System. TEWLS
is an information technology system within the Defense Medical
20 | Combat & Casualty Care | Winter 2016/2017

Logistics - Enterprise Solution portfolio that consolidates numerous
military logistics functions into a single application and database.
This process allowed USAMMA to optimize its existing inventory
-- rather than additional funding -- to field to the force approximately
$29M worth of life-saving medical equipment in fiscal year 2016. As
a result of these efficiencies, USAMMA was able to field or modernize
more than 140 Army units in fiscal year 2016 -- twice as much as
programmed--while expending the same amount of resources.

Army Medical Readiness Outlook
“Our priority is very simple,” said Lt. Gen. Nadja Y. West, commander
of Army Medical Command and surgeon general of the Army. “Chief of
Staff of the Army Gen. Mark A. Milley has told me and told us all what
that is. It’s readiness. [Milley] says, ‘readiness is number one and there
is no other number one.’
West and others spoke in September at the Association of the
United States Army’s Institute of Land Warfare “hot topics” forum:
“Army Medicine: Enabling Army Readiness Today and Tomorrow.”
During her remarks, West explained that, when it comes to Army
Medicine, she sees readiness as a three-pronged endeavor.
“The first prong is the “current fight.” That means having a force
that’s medically ready to undertake any mission or go anywhere when
asked. The medical force itself must be ready as well”, West added.
“The second prong is the “future fight.” That means having the medical

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capability and delivery that the Army and joint force needs. “The third
is the “always fight.” West said that means, “always taking care of
those entrusted to our care: Soldiers for Life and Family members.”

Current Fight
At AUSA, Brig. Gen. Michael J. Talley, command surgeon, Army
Forces Command, indicated that the Army is no longer using the Army
Forces Generation Model that it used during most of the years Soldiers
were deploying to Iraq and Afghanistan.
The Army is now using the Sustained Readiness Model, which
means all units must be ready to deploy at all times. “Non-deployables
are no longer acceptable,” he said, adding that, “demand is too high,”
referring to the fact that fewer Soldiers are being asked to do more
around the world. The Army has upgraded its e-Profile system by
adding a Commander Portal that gives commanders eyes on medical
readiness, he pointed out, from the unit level down to the individual
Soldier level. The portal gives commanders a real-time view of each
Soldier’s medical and dental readiness.
The Commander Portal is boosting readiness, he said. “Populations
can no longer hide two to three years” in a non-deployable status.
The medical readiness of the Guard is improving as well, according
to Brig. Gen. Jill K. Faris, assistant surgeon general for Mobilization,
Readiness and National Guard Affairs, Medical Services Corps.
Nationally, it has climbed from 20 percent ready in 2006 to 86.5
percent in 2016, he said.

Future Fight
Army researchers in a number of laboratories around the U.S.
are working on new technologies that can protect the Soldier of the
future on the battlefield and at home.
Col. Matthew Hepburn, an infectious disease physician and
program manager at the Defense Advanced Research Projects
Agency, said his team is intent on preventing a medical surprise that
could impact national security.
“DARPA is working on making devices that will be useful in
the future fight,” he said, “including one device, a Mobile Analysis
Platform, which is now in active transition to the Department of
Defense. The battery-operated, hand-held portable device takes
blood samples at the bedside and provides immediate and accurate
laboratory readouts.”
“The device could be transformational,” Col Hepburn said. “It
could save precious time waiting for lab results to be processed.”
DARPA is also developing a multiplex assay that will be able
to diagnose a Soldier with an infectious disease with immediate
readouts. The disease could be anything from influenza to dengue
fever or Ebola. Hepburn called it a “Swiss Army knife,” because
the device is meant to serve so many functions. It’s still in the
development stage. The agency is also working on sensors that
can be implanted in Soldiers’ skin to monitor such things as oxygen
uptake, he said.
More info: crdamc.army.mil

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There are two different versions of the OCID course,
The Walter Reed Army Institute of Research (WRAIR)
a 5 day course taught at WRAIR and a 3 day course
is a 123-year old institution tasked with researching
conducted at the requesting unit’s CONUS or OCONUS
ways to counter threats to the health of the U.S. military.
base or post. Both versions share a similar curriculum
“At the WRAIR, we have two fundamental programmatic
consisting of lectures and a laboratory session, but
lines of effort, one of which focuses on mental health,
the five day course has an expanded curriculum that
the other on infectious diseases” said COL (Dr.) Michael
addresses some additional pathogens and provides a
Zapor, WRAIR Deputy Commander for Operations and
little more detail. “The curriculum is continuously being
OCID Course Director. “The Center for Military Psychiatry
adapted, both in response to emerging infectious disease
and Neuroscience (CMPNS) focuses on the prevention,
threats as well as response to student feedback” noted
diagnosis, and treatment of both traumatic brain injury
COL Michael Zapor, PhD, MD,
Zapor. “We endeavor to ensure that the lectures are
(TBI) as well as post-traumatic stress disorder (PTSD).
CTropMed, FACP, FIDSA
relevant, informative, and appropriate for the attendees”.
In contrast, the Center for Military Infectious Diseases
The OCID is funded by the Global Emerging Infections
Research (CMIDR) researches pathogens that pose a
Surveillance (GEIS) section at the Armed Forces Health Surveillance
threat to the health of service members.” The CMIDR is comprised of
Branch (AFHSB) and is accredited to award either 40 Continuing Medical
a Bacterial Diseases Branch that focuses on enteric (gastrointestinal)
Education (CME) credits for the 5 day course or 18 CME for the 3 day
infections (primarily bacillary dysentery) and wound infections caused
course.
by multidrug resistant bacteria. Similarly, the CMIDR also consists of
The OCID course is highly regarded by medical personnel in field
a Virus Diseases Branch that focuses of flaviviruses such as dengue.
units and there is a high demand for attendance. Iterations of the course
“Our researchers have made significant contributions towards the
are run year round throughout CONUS as well as OCONUS locations
development of a number of viral vaccines including hepatitis A, the
such as Germany, Japan, and Nigeria and deconflicting schedules can
Middle East Respiratory Syndrome Corona Virus (MERS-COV), Zika, and
be a challenge. “We get requests from all of the Services as well as
Ebola” said COL Zapor. “Moreover, we have an entire program dedicated to
the occasional request from a non-DoD agency such as a civil police
researching a vaccine against the Human Immunodeficiency Virus (HIV).
department.
The Military HIV Research Program (MHRP), which is congressionally
Requests and repeat requests for course iterations, particularly
funded, has helped produce the only HIV vaccine to date proven to
by folks pending deployment, place a demand on the limited number
have any efficacy”. The CMIDR also consists of a large Military Malaria
of course lecturers, all of whom have full time jobs and voluntarily
Research Program (MMRP). “Malaria is the quintessential infectious
participate as OCID faculty” remarked Zapor.
disease threat to deployed service members” noted Zapor; and the
According to COL Zapor the OCID is patterned like a college course
MMRP has produced or improved most of the antimalarial drugs in use,
with lectures by core and adjunct faculty, each of whom is selected based
as well as the only malaria vaccine with any proven efficacy”. Infectious
on his or her expertise. The curriculum is continuously reviewed and
diseases research at WRAIR is supported by an Entomology Branch and
updated in order to keep it topical and relevant. “For example, because
insectary which breeds, infects, and maintains mosquitoes and sand
the distribution of Plasmodium (malaria) species varies geographically,
flies as well as a Veterinary Services Branch that includes a vivarium
malaria lectures given to those traveling to Africa may have a different
where rodents, nonhuman primates, and other animals are maintained.
emphasis than those traveling to South America. Similarly, travelers to
Additionally, the WRAIR maintains a pilot bio production facility that
Africa will spend more time learning about Ebola and related viruses
produces vaccines and other therapeutics under good manufacturing
endemic to that continent.” Regardless of the course content for a
practice (GMP) standards.
particular iteration, each begins with a lecture titled “Preparing the
In addition to its main campus in Silver Spring, Maryland, WRAIR
traveler” which addresses such topics as pre-deployment vaccinations
has a number of daughter sites both in the Continental United States
and prescriptions. Moreover, all lectures are similarly structured and
(CONUS), including one at Joint Base Lewis-McChord in Washington
begin with background information on the geographic distribution of the
State, as well as Outside the Continental United States (OCONUS),
pathogen, its reservoir in nature, and its vector (e.g. mosquito), if any.
including the Republic of Georgia, Kenya, and Thailand. In turn, the
This is followed by clinical presentation (i.e. the signs and symptoms
OCONUS sites have a number of smaller field sites, all arranged in a hubassociated with infection), how the disease is diagnosed, how infected
and-spoke manner. “Throughout the WRAIR CONUS and OCONUS labs,
patients are treated, and lastly, how infection may be prevented
research is being done in collaboration with other governments, with
(e.g. by means of vaccination or prophylactic medications). “Unlike
industry, and with academia” said Zapor.
the other more comprehensive tropical medicine courses, the OCID
course presupposes that the deployed provider will have very limited
Infectious Disease Awareness
diagnostic capabilities and a limited formulary” Zapor noted. “Therefore,
the OCID course emphasizes such topics as physical exam findings,
The Department of Defense runs a number of tropical medicine
empiric treatment of disease (i.e. treatment based on experience and
courses, including the Military Tropical Medicine Course at the Uniformed
observation rather than definitive diagnosis), and when to consider
Services University of Health Sciences (USUHS). “However, these
medical evacuation (MEDEVAC) of patients to a higher level of care.”
are graduate level courses that are intended for infectious diseases
specialists and other physicians for whom comprehensive training in
tropical medicine is appropriate” said Zapor. “In contrast, the Operational
Diagnosis by Teleconsultation
Clinical Infectious Disease (OCID) course offered at WRAIR is designed
for primary care physicians, physician assistants, medics, and corpsmen
Not part of the OCID program but another resource available to
who will be deploying to regions in which certain infectious diseases are
deployed providers is the Army’s telemedicine consultation program
endemic.”
in infectious diseases (id.consult@us.army.mil). This program

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Winter 2016/2017 | Combat & Casualty Care | 23

Classroom in Okinawa, Japan for the students with the 1st Battalion / 1st Special Forces
Group. (Airborne)

enables deployed medics, physician assistants, and physicians
to solicit advice from infectious diseases specialists assigned to
Medical Centers (MEDCENS). The typical consultation includes a case
presentation consisting of the history of the present illness, physical
exam findings, etc. Oftentimes, providers will attach photographs of
relevant exam (e.g. rash) or microscopic findings (e.g. questionable
malaria on a blood smear). “Once the on-call physician replies to
the consultation, it is fair game for other infectious disease docs to
weigh in with their opines” said Zapor. “What ensues is a back-and-

forth dialogue between the deployed provider and the consultants
consisting of recommendations, updates, and so forth. Thus, no
matter how remote a deployed provider may be and no matter how
limited the resources, expert consultation is just an email away.”
According to COL Zapor, the success of the OCID course is
paradoxically its biggest challenge. “The requests from units exceed
the availability of our faculty. Consequently, we have to limit the
course offerings to one 3 day iteration per month and one 5 day
iteration per quarter. Additionally, we have to screen the requests
and prioritize them based on need and urgency.” Zapor added “We
are continuously looking at ways to improve course content and
delivery, including recorded lectures and a handbook. Our faculty has
substantial expertise in tropical and other infectious diseases that
we want to leverage to the benefit of the deployed provider.”
For more information on the course and availability, please
contact the Deputy Director for Operations, OCID - Mr. Douglas Davis
at usarmy.detrick.medcom-wrair.mbx.ocid@mail.mil.

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Agency Spotlight Veterans Administration

ADVANCING
THE
PROVISION
OF
ADVANCED
CARE

The U.S. Veterans Administration has undertaken a process standardization effort which
includes a re-investment in patient care through enhanced facility management, supply chain
function, management training, and overall cost reduction across the board.
By Kevin Hunter, C&CC Editor
The second largest federal government installation, the U.S.
Veterans Administration or “VA” has a budget of $183B and comprises
six enterprise centers and many hundred service level agreements
with both government and industry. Recently, the VA has launched
an ongoing process enhancement effort entitled MyVA which focuses
on improving the Veteran’s experience, employee’s experience and
empowerment, shared service excellence, continuous performance
improvement, and developing strategic partnerships. The effort aims
to achieve shared services excellence is directly focused on improving
the Veteran’s experience and delivering consistent Veteran outcomes.
VA work to develop and implement an integrated medical surgical
supply chain across the enterprise is on track to return over $150M to
our medical centers, which in turn can be used to hire additional nurses
and clinicians and directly enable more appointments and access for
Veterans to high quality healthcare.
26 | Combat & Casualty Care | Winter 2016/2017

“It all began for us by measuring enterprise performance and
making good data-driven decisions,” said Thomas Muir, Executive
Director, Support Services, MyVA Program Office. “By mapping our
performance against our customer’s journey, we are able to focus
on metrics that support their performance of business outcomes –
measured in improvements to the Veteran and employee experiences,
in moments that matter.”
Due to its sheer scale as the second largest agency in the federal
government, the VA has unique opportunities to change the federal
service landscape through our use of shared services. For example, it
has over 35,000 employees delivering service at over 1,600 facilities
and points of service in HR, IT, finance and contracting today in a
very decentralized, distributed process aligned with unique business
lines and often providing variable outcomes. “Imagine a future where
VA consolidates and standardizes the work, integrating the latest

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Agency Spotlight Veterans Administration

information technology and automation, enabling us to focus on
exceeding customer’s expectations for service levels, quality and
lower costs for the activities that directly impact Veteran’s healthcare,
benefits and memorial services,” remarked Muir. “We are at a unique
point in history to make substantive changes to our processes to
become a more Veteran-centric organization,” he emphasized.

Implementation
The VA is today moving towards implementation of a MyVA
mapping capability where the agency delivers improved customer
support services when needed. “We had to answer the question and
prove how establishing a new HR enterprise center delivers better
customer service,” noted Muir. We are early in this journey but have
already earned the trust of leadership through proven performance.

develop a capital reserve, and make sound investment decisions to
innovate and expand services. “By measuring our performance in a
transparent, data-driven way, we are able to move at the speed of
opportunity and make good business decisions to invest franchise
fund reserves to stand up new enterprise centers that solve pain points
for our business leaders and facility directors, and directly contribute
to better lives for Veterans and their families,” remarked Muir.
“We are literally changing all of our business processes to focus
on the Veteran’s journey – to make VA easy, effective and emotionally
connected to delivering a consistent Veteran experience at all touch
points in their journey to receive the health care and benefits they have
earned through their service to our country,” noted Muir. “Our journey
is very much like the large private sector company’s journey to shared
services – it requires high level buy-in to be successful. We began
our journey by redefining the work that supports consistent Veteran

“We are literally changing all of our business processes to focus
on the Veterans’ journey” — Thomas Muir
For the first time in VA’s history, we are measuring performance
of our enterprise centers in a transparent, meaningful way. We are
benchmarking our current levels of performance using a dashboard
holding us accountable to our customers and governance board.”
What makes the MyVA effort unique is that the Administration
manages a $1.1B franchise fund, a revolving fund to recover costs,

outcomes, in particular HR, IT, finance, procurement and leasing.” The
VA is looking at work supporting improved employee outcomes like
enterprise training. As such, the Administration is re-designing itself to
deliver improved customer satisfaction, service quality, while reducing
costs across the board.
More info: va.gov

29th National Symposium

Distributed Lethality:
Enabling Sea Control

10-12 January 2017
Hyatt Regency Crystal City

Registration Opens 1 November

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Winter 2016/2017 | Combat & Casualty Care | 27

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Training time is valuable,

why WASTE it on
SET UP and RESETS?
Fast set-up allows for more scenarios, more hands-on
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> Adapts to Actors or TOMManikin®